Puerperal sepsis in the Maltese Islands

Abstract

The turning point in the control of puerperal sepsis in the Maltese Islands occurred in the last decade of the nineteenth century and received a major impetus after 1935 with the introduction of antimicrobials. With the realisation of a medical or paramedical contribution towards the spread of infection, legislative measures were undertaken at the turn of the century to ensure control of this important contributor to maternal mortality. The legislative efforts were rewarded by a significant fall in the puerperal sepsis incidence rate to reach a rate of about 2 per 1000 births within two years. This level was maintained until the First World War after which a gradual rise in incidence became apparent. This rise continued steadily in the subsequent decade to reach the mean figure of 7.51 per 1000 births in 1937–39, suggesting increasingly poor standards of practice, particularly in domiciliary practice. The Second World War served as a turning point as it was followed by a fall in incidence of puerperal sepsis that can only be attributed to better supervision of peri‐puerperal care. At this period a drop in case fatality rate could also be observed reflecting the introduction of antimicrobial agents such as the sulphonamides (1935) and penicillin (1944). The continued emphasis of tackling this infectious disease on two fronts – namely that of prevention and that of cure – have ensured that puerperal sepsis has become a very rare cause of maternal mortality.